5 Pulmonology Headlines You Missed in March 2026

The pulmonology field closed out March 2026 with a pipeline signal that may redefine how the field thinks about biologic therapy in chronic obstructive pulmonary disease (COPD). The month's headline result came from AstraZeneca's IL-33 inhibitor tozorakimab, which met its primary endpoint in both the replicate phase 3 OBERON and TITANIA trials across a broad COPD population regardless of eosinophil count or smoking status — a meaningful differentiation from the type 2–restricted mechanisms that have dominated the space thus far. The topline announcement arrived without granular efficacy data, but the confirmatory design and breadth of the enrolled population give the signal real weight, and the result landed alongside a contextualizing expert forum on HCPLive in which clinicians laid out, with unusual candor, how they actually navigate biologic selection in asthma and COPD — and where the current toolkit still falls short.

The rest of the month mixed regulatory momentum with diagnostic reform. ENCORE data for Arikayce (amikacin liposome inhalation suspension) in antibiotic-naïve MAC lung disease fulfilled an FDA post-marketing requirement and positioned Insmed for a label expansion filing, adding durable culture conversion rates exceeding 76% to a trial that enrolled a meaningfully broader population than the refractory indication that preceded it. On the diagnostic side, AAAAI 2026 offered a population-based reminder that race-adjusted spirometry equations continue to misclassify disease severity — with downstream effects on treatment, disability assessments, and transplant timing — and a separate cross-sectional analysis from Helsinki extended the unified airway model into laryngeal territory, finding that women with respiratory allergies carry a disproportionate burden of vocal symptoms that clinicians are not systematically screening for.

Check out this March 2026 pulmonology month in review for a recap of HCPLive's coverage of the top news and research from the past few weeks:

1. IL-33 Inhibitor Tozorakimab Cuts COPD Exacerbations in Phase 3 Trials

Tozorakimab, an investigational monoclonal antibody targeting IL-33, met its primary endpoint in both the phase 3 OBERON and TITANIA trials, reducing moderate-to-severe COPD exacerbation rates compared with placebo in former smokers and in the overall population, which included current smokers across all eosinophil levels and lung function severity stages. The results, announced by AstraZeneca on March 27, position tozorakimab as the first IL-33–targeting biologic to demonstrate significant exacerbation reduction across 2 replicate confirmatory trials in a broad COPD population; specific rate ratios and P values were not disclosed in the high-level announcement. Full data are expected at an upcoming medical meeting, with 2 additional LUNA program trials — PROSPERO and MIRANDA — still ongoing.

2. ENCORE: ARIKAYCE Meets End Points, Improves Respiration in MAC Lung Disease

Insmed's phase 3b ENCORE trial of amikacin liposome inhalation suspension (Arikayce) plus guideline-based multidrug therapy met its primary endpoint and all multiplicity-controlled culture conversion endpoints in antibiotic-naïve patients with a new MAC lung infection, with culture conversion by month 6 achieved in 87.8% of treated patients versus 57.0% on placebo and durable conversion at month 15 in 76.2% versus 47.6%. The results fulfill an FDA post-marketing requirement associated with Arikayce's existing accelerated approval for refractory MAC lung disease, and Insmed plans to file a supplemental NDA in the second half of 2026 seeking both label expansion into the antibiotic-naïve population and conversion to traditional approval. The ENCORE population is meaningfully broader than the refractory indication that preceded it, and the 30-percentage-point gap in 6-month culture conversion underscores the magnitude of added benefit over multidrug therapy alone.

3. COPD Biologics in Practice: Exacerbation Reduction No Longer Enough

An HCPLive virtual expert forum moderated by MeiLan Han, MD, MS, examined how pulmonologists navigate biologic selection across severe asthma and COPD, with panelists identifying dupilumab as the dominant first choice in both indications — driven by its dual IL-4/IL-13 blockade, nasal polyp and eczema comorbidity coverage, and FEV₁ improvement signal in COPD — while reserving IL-5 agents primarily for patients with very high eosinophil counts or dupilumab access barriers. The discussion surfaced a core clinical tension in COPD biologic therapy: even when exacerbation rates decline, patients do not always perceive functional improvement, complicating shared decision-making in a way that rarely arises in severe asthma. Panelists also addressed persistent access friction — J-code delays, step therapy requirements, and upstream oral corticosteroid overuse from urgent care — as practical barriers that trial data cannot resolve.

4. Race-Neutral Spirometry May Improve Diagnostic Accuracy — Nicole Ramsey, MD, PhD

Speaking at AAAAI 2026 in Philadelphia, Nicole Ramsey, MD, PhD, of Icahn School of Medicine at Mount Sinai, made the case for adopting race-neutral spirometry reference equations — including the GLI 2022 global equations — arguing that race-adjusted equations misclassify disease severity by treating race as a biological rather than social variable, with measurable consequences for treatment access, disability compensation, and transplant timing. Analyses she cited suggest Black and Asian veterans with COPD may have been undercompensated in disability assessments relying on race-adjusted thresholds, with monthly payment differences of up to $3,000 in some cases, and that Black patients could qualify for lung transplant listing sooner under race-neutral standards. Ramsey acknowledged the equations are imperfect but argued they represent the most accurate available tool for consistent, equitable spirometry interpretation across populations.

5. Respiratory Allergies Linked to Vocal Symptoms — Holmqvist-Jämsén, PhD

A cross-sectional analysis of 1,220 Finnish adults found that individuals with diagnosed respiratory allergies were significantly more likely to report 2 or more frequent vocal symptoms — including hoarseness, voice fatigue, and throat tension — compared with nonallergic peers (24.6% vs 18.2%; P <.05), with the association driven primarily by women, among whom 30.2% of those with allergies reported elevated symptom burden versus 20.4% without (P <.01). Investigator Sofia Holmqvist-Jämsén, PhD, of the University of Helsinki, framed the findings within the unified airway model, proposing that allergic mucosal inflammation and postnasal drip contribute to laryngeal dysfunction through edema and altered vocal fold vibratory mechanics. The study relied on self-report without laryngoscopic validation, but the authors suggested the results support proactive vocal symptom screening — particularly in women — as part of routine allergy management.